Document Detail

Vertebral artery complications in anterior approaches to the cervical spine: report of two cases and review of literature.
MedLine Citation:
PMID:  12748015     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cases of lesions to either the carotid artery or the vertebral artery in anterior approaches to the cervical spine are rarely found in medical literature. Two cases of vertebral artery injury in anterior approaches as well as a review of the pertinent literature are presented. In cases of arterial injury, appropriate management strategies are necessary to avoid or minimize harm to the patient. CASE REPORTS: In the first case, the vertebral artery was injured during decompression of a cervical spinal stenosis while drilling the neuroforamen. Local compression provided sufficient control of hemorrhage. Nevertheless, rebleeding from a pseudoaneurysm occurred 2 days later. After removal of the hematoma, the pseudoaneurysm was treated successfully with coils by an endovascular approach. In the second case, misplacement of one screw in screw-fixation of a type II odontoid fracture caused a pseudoaneurysm of the vertebral artery. This led to a fatal subarachnoid hemorrhage 4 days later. CONCLUSIONS: In ventral approaches to the cervical spine, precise preoperative planning and a detailed knowledge of the surgical anatomy are mandatory. In cases of injury to the vertebral arteries, direct surgical repair is most appropriate to prevent complications arising from fistulas, late-onset hemorrhages, pseudoaneurysms, thrombosis, and emboli. Alternatively, endovascular techniques or even clipping or ligation of the affected artery should be considered.
Dorothea Daentzer; Wolfgang Deinsberger; Dieter-Karsten Böker
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Surgical neurology     Volume:  59     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-05-15     Completed Date:  2003-05-27     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  300-9; discussion 309     Citation Subset:  IM    
Neurosurgical Clinic, Justus-Liebig-University Giessen, Giessen, Germany.
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MeSH Terms
Aneurysm, False / etiology
Bone Screws
Cervical Vertebrae / pathology,  surgery
Decompression, Surgical / adverse effects*
Fatal Outcome
Middle Aged
Postoperative Complications*
Spinal Stenosis / surgery*
Subarachnoid Hemorrhage / etiology*,  pathology
Vertebral Artery / injuries*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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